(b) I was a member of _____________________________________________Provident Fund and also of the family pension fund from ________________________to ___________________and my account number(s) was / were ___________________________________________________

(c) I have / have not withdrawn the amount of my Provident Family Pension Scheme.

(d) I have / have not drawn superannuation benefits in respect of my past services from an employer.

(e) I have never been a member of any Provident fund and / or Family Pension Scheme.

Date ___________________________ Signature or right / left hand thumb impression of the employee.

(To be filled in by the employer only when the person employed had not already been a member of the Employees’ Provident Fund)

Shri_______________________________________ is appointed as _______________________________

(Name of the employee) (Designation)

in ____________________________________________________________________________________

(Name of the Factory / establishment)

with effect from ______________________________.

(Date of Appointment)

Date_________________________ Signature of the employer or Manager or other authorized Officer

N.B.: The Principal employer should have filled it up also n respect of employees to be employed by through a contractor.

Attached find the Minimum Wages Circular i.r.o the employment of Construction & Maintenance of Road or in Building Operations in West Bengal and a calculation sheet of VDA (ZONE – A & B) w.r.t Minimum Wages (u need to change only the rise in CPI for unskilled workers in excell sheet- U will get Minimu Wages of all category).